Home Canning Literature Review June 2014 Public Health Ontario Public Health Ontario is a Crown corporation dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. Public Health Ontario links public health practitioners, frontline health workers and researchers to the best scientific intelligence and knowledge from around the world. Public Health Ontario provides expert scientific and technical support to government, local public health units and health care providers relating to the following: communicable and infectious diseases infection prevention and control environmental and occupational health emergency preparedness health promotion, chronic disease and injury prevention public health laboratory services Public Health Ontario's work also includes surveillance, epidemiology, research, professional development and knowledge services. For more information, visit www.publichealthontario.ca How to cite this document: Ontario Agency for Health Protection and Promotion (Public Health Ontario). Home canning: literature review. Toronto, ON: Queen's Printer for Ontario; 2014. ISBN 978-1-4606-4166-8 [PDF] Public Health Ontario acknowledges the financial support of the Ontario Government. ©Queen’s Printer for Ontario, 2014 Author Naghmeh Parto, MSc. CPHI (c) Senior Program Specialist Environmental and Occupational Health Team Public Health Ontario Acknowledgements Robert Blenkinson, PhD Food Scientist, Horticulture Food Safety Science Unit Ontario Ministry of Agriculture and Food Anne Maki Manager, Enteric and Molecular Surveillance Public Health Ontario Laboratories Food Safety Working Group Canadian Institute of Public Health Inspectors - Ontario Disclaimer This document was developed by Public Health Ontario (PHO). PHO provides scientific and technical advice to Ontario’s government, public health organizations and health care providers. PHO’s work is guided by the current best available evidence. PHO assumes no responsibility for the results of the use of this document by anyone. This document may be reproduced without permission for non-commercial purposes only and provided that appropriate credit is given to Public Health Ontario. No changes and/or modifications may be made to this document without explicit written permission from Public Health Ontario. Contents Home Canning................................................................................................................................. 1 Background and Objective ........................................................................................................................ 1 Method ..................................................................................................................................................... 2 Discussion.................................................................................................................................................. 2 Reported illnesses and outbreaks associated with the canning process.............................................. 2 Effect of acidity and processing temperature of food on the safety of canned products.................... 6 Acidity ............................................................................................................................................... 8 Temperature ..................................................................................................................................... 8 Other Factors ........................................................................................................................................ 9 Food service establishments and canning .......................................................................................... 10 Conclusion ............................................................................................................................................... 10 References .............................................................................................................................................. 12 Appendix I ............................................................................................................................................... 16 Background and Objective Canning is the method of food preservation where food is treated by the application of heat alone, or in combination with pH and water activity, then stored in hermetically sealed containers. Home canning is the process of preserving foods such as fruits, vegetables, and meats, by packing them into glass jars and heating the jars to eliminate organisms that would create spoilage. Nicolas Appert, a French chef (1749-1841), known as the “father of canning”, developed the first commercial canning process. In 1810, he was awarded a prize by the French military for his method of preservation that included cooking foods in sealed jars at high temperatures.1 Since then the canning industry has grown rapidly; it is now a multi-billion dollar business. Today’s canning industry uses high speed, high temperature and precise equipment that can produce a large volume of canned foods in a very short period of time. Key Messages Home canning has been regaining popularity in Canada. In Canada and internationally, there are many reports of foodborne illness and outbreaks associated with improperly home-canned food. Shelf-stable homecanned products containing low acid foods such as vegetables and meat dishes are often implicated as contributing factors in Clostridium botulinum illnesses and outbreaks. Spore-forming bacteria, including Bacillus and Clostridium botulinum, are a concern in the canning process. These spores are common in the environment. Failure to meet the posted or correct thermal process or acidity requirements, are the primary causes of botulism illnesses and outbreaks. Home-canned food is now available for sale in some retail food establishments. Food service establishments are potential high risk settings where widespread public exposure to contaminated food (including home-canned items) can occur. Use of a validated recipe and design of a satisfactory HACCP-based process that includes achieving the required temperature, water activity and acidity to control or eliminate the growth of microorganisms of concern, and adequate delivery of this process, are necessary for the production of a safe canned product. Traditionally, home canning was a term used for canning at home; however, it is now also commonly used for small scale canning operations who sell to the public at food establishments and farmers’ markets. There are two different processing methods for home canning: boiling water bath canning and pressure canning. Boiling water bath canning is used for high-acid or acidified foods, while pressure canning is applied to low-acid foods.2–4 Low-acid foods are any foods with a finished equilibrium pH of greater than 4.6 and water activity of greater than 0.85. Acidic foods are foods that have a natural equilibrium pH of 4.6 or less. Acidified foods are low-acid foods to which acid or acid foods are added; they have an equilibrium pH of 4.6 or less and a water activity greater than 0.85.5 Water activity describes the amount of water available in food; pure water has water activity of 1 and water activity of zero refers to the total absence of free Home Canning |1 water molecules. U.S. Food and Drug administration defines water activity of a food as the ratio between vapor pressure of food, when in a completely undisturbed balance with the surrounding air media, and the vapor pressure of distilled water under identical condition.6 In Canada, home canning has been regaining popularity as part of the local food movement and the desire to be more environmentally friendly.7 Some restaurants across Ontario are also responding to this movement and including home-canned food as part of their menu. However, if home-canned foods are not prepared properly, they can cause foodborne illness. This review will address the incidences and hazards of foodborne illness with improperly home-canned food, and the effect of acidity and temperature in controlling these hazards. Method Five databases were searched (MEDLINE, Embase, CINAHL, Environment Complete, and Scopus); results were limited to English language and duplicate records were removed. Appendix I outlines the search strategy used for this review. Additional information was found by checking references of obtained articles. All records were reviewed and 41 records were included in this report. Discussion While canning can be a safe way of preserving and storing food for a prolonged period of time, if not done properly, it can be associated with illnesses and health hazards. The following is a summary of the results obtained from a recent literature review on the reported illnesses, outbreaks and health hazards associated with the canning process, and the effect of temperature and acidity of food on the safety of home-canned products. REPORTED ILLNESSES AND OUTBREAKS ASSOCIATED WITH THE CANNING PROCESS In Canada and internationally, there are many reports of foodborne illnesses and outbreaks associated with improperly canned food.8-10, 14-32 Shelf-stable home-canned products containing low acid foods such as vegetables and meat dishes are often implicated in these illnesses and outbreaks. There are also reports of foodborne illness associated with large scale commercial canned food. For example, in the United States (US) in 1989, four outbreaks of staphylococcal food poisoning were linked to improperly canned mushrooms. Ninety-nine people were reported ill, eighteen of whom were hospitalized. Staphylococcal enterotoxin A was identified in the canned mushrooms.8 Another example included three cases of foodborne botulism in 2003 reported in South Korea; commercially canned sausage was identified as the most likely source of infection for this outbreak. 9 However, due to advances in food Home Canning |2 science, at the beginning of the 20th century the number of epidemics associated with commercial canned foods has reduced considerably. Nevertheless, home-canned food still represents one of the main causes of reported botulism cases around the world.10 Improperly prepared shelf-stable home-canned food is associated with incidents of foodborne botulism in Canada, the US and other countries. Foodborne botulism is a rare but serious paralytic illness in humans. It is caused by consuming food contaminated with the pre-formed botulinum toxin.11 Shelfstable food refers to processed food that can be safely stored at room temperature for specified long period of time without significant deterioration of quality. These products are free of microorganisms capable of growing in or on the product at non-refrigerated conditions.12,13 The low acid, shelf stable, home-canned foods with anaerobic environments provide an optimal growth condition for C. botulinum spores, allowing for the growth and production of toxins in the finished product if the spores have not been effectively inactivated during the canning process. Following are examples of botulism illnesses and outbreaks associated with home-canned food where low-acid food (vegetables and meat) are most frequently implicated. Table 1 provides a summary of the published reports of botulism illnesses associated with home-canned food for the period of 2003 to 2013. Table 1: Summary of reported illnesses and outbreaks of foodborne botulism associated with homecanned food published from 2003 to 2013. Reference Year of Event Location Number of cases* Most Likely Source(s) Contributing Risk Factor(s) Loutfy MR. et al., 200314 1999 CanadaOntario 3 Home-canned tomatoes Inadequate pH of the final product Abgueguen P., 200315 2000 France 9 Home-canned asparagus Not recorded Armada M. et al. 2003.16 2003 United States 1 Home-canned baby food Inadequate temperature treatment 70 Home-canned vegetables, homecanned soup, stew, chili, tuna, egg and garlic in oil*** Not recorded 565 Home preserved vegetables (implicated food for 80% of botulism cases) Inadequate sterilization equipment and temperature treatment, canned food stored for too long and preserved vegetables eaten uncooked. Sobel J. et al. 2004**17 Varma KJ.,2004 **18 19902000 19802002 United States Georgia Home Canning |3 Reference Year of Event Cengiz N., et al. 200419 2004*** * Turkey 1 Home-canned green beans Not recorded Cawthorne A. et al. 2005 2004 Italy 28 Restaurant-preserved green olives in saline Inadequate pH of the final product Peck MW., 20069 2004 Kyrgyzstan 5 Home-canned aubergine Not recorded Peck MW., 20069 2005 Russia 16 Home-canned cucumbers Not recorded Peck MW., 20069 2005 Kyrgyzstan 6 Home-canned salad Not recorded Peck MW., 20069 2005 Russia 5 Unspecified homecanned food Not recorded Peck MW., 20069 2005 Russia 15 Unspecified homecanned food Not recorded 20 Location Number of cases* 3: Mclauchlin J. et al. 2006**21 2 1998 2005 United Kingdom 1 Most Likely Source(s) Imported homecanned mushrooms in oil (Italy) Imported homepreserved pork (Poland) Contributing Risk Factor(s) Not recorded Inadequate temperature treatment Cengiz M., 200622 2005 Turkey 5 Roasted home-canned mushrooms Not recorded Pavlova V. et al. 200723 2005 Bulgaria 3 Home-canned pork Not reported CDC, 200624 & Ungchusak K. et al. 200725 2006 Thailand 163 Home-canned bamboo shoots Inadequate temperature treatment Home Canning |4 Reference Year of Event Location Number of cases* Most Likely Source(s) Storing food under conditions that benefits the toxin’s growth Inadequate pH of the final product Rebagliati V. et al. 2009**10 19922004 Argentina 41 Improperly processed meats and vegetables and home-canned food: onions, pickled octopus, asparagus, fish and sweet corn. Swaan CM., 201026 2008 Netherlands /Turkey 8 Home-packed black olives United States: Contributing Risk Factor(s) Home-canned vegetables (blend of carrots, beans, green beans, asparagus) Date K, et al., 2011**27 20082009 Oriot C., et al. 201128 2010 Corsica 5 Home-canned green beans and/or salted roast pork Inadequate temperature treatment Lonati D. et al. 201129 2011*** * Italy 1 Home-canned homogenized turkey meal Inadequate temperature treatment Ağaçayak A. 201130 2011*** * Turkey 4 Home-canned red peppers Not reported Not reported Not reported Ohio and Washington 12 Home-canned vegetables accounted for 56% of botulism outbreaks in the United States between 2008 and 2009. Leclair D., et al. 2013**31 19852005 Canada 18 Restaurant homecanned mushrooms; home-canned vegetables (mushrooms and asparagus); beef and vegetable soup; and sausage Hill SE., et al. 201332 2013*** * United States 1 Home-canned corn Inadequate temperature treatment Note: * Studies where number of cases where divided into confirm and suspect; sum of cases were reported in this table. **Meta analysis studies, the number of case reported are sum of reported cases. *** Home-canned vegetables reported included: Asparagus, squash, peppers, corn, beans, pumpkin, greens, tomato juice, olives, beets, potatoes, eggplant, turnip, carrot, pickles and garlic. **** Year of publication was used when there was no information on the year the cases were reported. Home Canning |5 EFFECT OF ACIDITY AND PROCESSING TEMPERATURE OF FOOD ON THE SAFETY OF CANNED PRODUCTS Spore-forming bacteria, including Bacillus species and Clostridium botulinum, are the key organisms of public health significance in the canning process. These spores are common in the environment and have been found in various food ingredients. Spores are the dormant stage of the microorganism; they have the ability to survive a wide range of adverse conditions and will germinate and grow when conditions are favourable. Types of microorganisms deemed to be critical in designing a safe canning process are: Clostridium botulinum ; resistant mesophilic , spore-forming bacteria; and thermophilic, spore-forming microorganisms.33 Thermal process, or the combination of temperature and time required for safe canning of a food product, is based on the most heat-resistant organism associated with the food. The pH, or acidity of the food product, is the main factor in identifying the type of microorganism that should be controlled in canning process.5 Table 2 provides information on the reference temperature associated with effective treatment of microorganisms, based on the pH of food that is being canned. The D-value refers to decimal reduction time which is the time required to kill 90% of the organisms being studied at a reference temperature. The Z-value of an organism refers to the temperature required for one log reduction in the D-value.34 Table 2: Microorganisms Associated with Thermally Processed Canned Foods5 Class of Food Type of Microorganism(s) Microorganism Thermophiles (spores) Low-acid food (pH > 4.6) Acid food and acidified food (pH Reference Temperature (°F/C) D-Value (minutes) Z-Value (°F) Flat-sour group (G. stearothermophilus) 250/121 4.0 – 5.0 14-22 Putrefactive anaerobes (C.botulinum types A and B) 250/121 0.10 – 1.20 14-18 C. sporogenes group (including P.A. 3679) 250/121 0.10 - 1.5 14-18 Thermophiles (spores) B. coagulans (facultatively mesophilic) 250/121 0.01 – 0.07 14-18 Mesophiles B. polymyxa and 212/100 0.10 – 0.50 12-16 Mesophiles (spores) Home Canning |6 Class of Food Type of Microorganism(s) Microorganism 4.0 – 4.6) (spores) Acid food and acidified food (pH < 4.0) Yeasts, molds, and mesophilic non-sporebearing bacteria Reference Temperature (°F/C) D-Value (minutes) Z-Value (°F) B.macerans Butyric anaerobes (C.pasteurianum) 212/100 0.10 – 0.50 12-16 B.licheniformis 200/94 4.5 27 Lactobacillus species, Leuconostoc species 150/66 0.50 – 1.00 8-10 Note: Thermophilic microorganism refers to an organism that thrives at a relatively high temperature, such as 50°C/122°F or above Mesophilic microorganism refers to an organism that thrives at a moderate temperature, such as 37 °C/99°F Faculative microorganism refers to an organism that can live under more than one set of environmental conditions An application of high temperatures and/or an acidic environment are required to effectively control and eliminate the growth and germination of bacterial spores during the canning process.35 Clostridium botulinum spores and toxins are resistant to freezing temperatures. The spores can germinate and produce toxins in low acid food with an equilibrium pH of more than 4.6, in an anaerobic environment of less than 2% oxygen, at temperatures of 4° – 50°C and water activity of greater than 0.85.36 The nonprotelytic Clostridium botulinum strains (B,E,F) strains can grow at refrigerated temperatures. 37 Botulinum toxins can be inactivated at 85°C/185°F for a minimum of five minutes, but the spores are resistant to heat and require high temperatures to eliminate.22 Botulinum spores can be effectively treated at temperatures of 121°C /250°F or higher. The production of botulism toxin can be eliminated by preventing the growth and germination of the spores. Botulinum spores will also not germinate in an acidic environment with an equilibrium pH value of 4.6 or lower. An acidic canned food that has gone through sufficient heat treatment to eliminate vegetative microorganisms (bacteria, yeasts and molds) will not support the germination and growth of botulinum spores and production of the toxin. Design of a satisfactory Hazard Analysis Critical Control Points (HACCP)-based process that includes achieving required temperature and acidity to control and eliminate the growth of these microorganisms, and an adequate delivery of this process are necessary for the production of a safe canned product.3,33 Home Canning |7 ACIDITY The US Food and Drug Administration (FDA) has identified improper acidification of home-canned foods as the cause of several botulism cases.38 Acidity, or pH value of the home-canned product, and processing time are two of the key factors that control the growth of microorganisms in canned food. Reducing the pH in food can prevent the outgrowth of spores, reduce the heat resistance of microorganisms, and inhibit or decrease their growth rate.38 A neutral pH or a pH of near 7.0 provides an ideal growth condition for C. botulinum spores and the production of toxins. The goal of acidification process is to reduce the finished product equilibrium pH to below 4.6. This takes into account the possibility of inter-or-intra-batch variability in the formulation of the home-canned food. The techniques for reducing pH are: 1. Blanching food ingredients in acidified aqueous solution. 2. Immersion of blanched food in acid solution: the food product is blanched in a steam or water blancher followed by dipping into an acidic solution before being placed in containers. 3. Direct batch acidification: ingredients are mixed and acid is directly added to the batch. The product is heated and the high temperature improves the rate of penetration into solid particles; pH of the final product is checked prior to filling the containers with product. 4. Direct addition of acid to individual containers. 5. Adding acidic food to low-acid food, in controlled proportion, following a specific validated recipie.38 Of the five techniques for acidifying vegetables mentioned above, the first three are generally used by the industry. Some of the concerns associated with last two methods include overlooking individual containers, inadequate mixing, and insufficient acid penetration into food particles.38 Regardless of acidification technique used, the acid concentration, blanch time, and temperature of the product must be carefully controlled and checked to ensure the safety of the canned food. Acidity of the final product can be verified by accredited laboratories. Accredited laboratories in Ontario may be located through the Standards Council of Canada website, http://palcan.scc.ca. In addition, Public Health Ontario Laboratories (PHOL) provides laboratory services to local health units across the province such as microbiological and physiochemical testing of food samples for food safety investigations. If a public health inspector has concerns regarding the safety of a specific product, pH analysis or measure of the acidity of home-canned foods and analysis of water activity can be performed upon request. Routine testing of home-canned foods is not a program supported by the PHOL. Results are available within 48 hours of receiving the food sample at the testing laboratory. TEMPERATURE Application of temperature is required to control and eliminate the germination and growth of microorganisms. The temperature, the length of time for temperature treatment and the applied pressure required to guarantee the safety of canned food depends on the pH of the food. Canned food can be divided into two groups: acidic or acidified, and low-acid food. Home Canning |8 To guarantee the safety of acidic and acidified home-canned food, it is recommended that the product undergo heat treatment at 100°C for a period of time indicated in the tested preserving recipe/validated recipe.3,38 Boiling of water is not a good indicator of heat treatment to 100°C. The boiling temperature of water varies with altitude.3 For example, Ontario’s highest point is the Ishpatina Ridge at 693 m, and the lowest point is Hudson Bay at sea level. This translates to a water boiling temperature of 97.7°C at Ishpatina Ridge and 100°C at Hudson Bay.39 It is recommended that a thermometer be used to ensure the required time-temperature combination is attained. Low-acid foods can be sterilized at a temperature of 116° to 121°C /240° to 250°F. Pressure canning must be used for low-acid foods. The processing time needed to eliminate microorganisms in low-acid food ranges from 20-100 minutes.3,38 The length of time required for temperature treatment of canned food depends on thermal conductivity and thermal diffusivity of the food items. It varies by the initial pH value of the food, initial temperature of food as it is filled into jars, shape and size of the container, the packing method and type/amount of food to be canned, i.e. types and amounts of particulate and liquid, size of particulates, product viscosity and presence of ingredients such as fat, starches and hydrocolloids.2,40 Following the correct temperature, processing time and pH requirements for canning food is critical to producing a safe product. Between 1910 and 1989, between 4 and 13 botulism outbreaks per year in the US were likely caused by human error in delivering the required thermal process for a specific system and this is the primary cause of botulisms.33 Use of validated canning recipes, from reputable sources, assists in production of a safe product. Validated canning recipes are recipes upon which verification tests for C. botulinum have been performed to identify the temperature, processing time, and acidification requirements to effectively inactivate the C. botulinum spores. The recipe will include such information as container type and size, ingredients, acidity/pH and time and temperature requirements for the food item that is being canned. The National Centre for Home Food Preservation4 and Ball Corporation41 are examples of sources of validated home canning recipes. While botulinum spores can survive in boiling water, the botulinum toxin is heat-labile. When possible, heating canned food to a temperature of 85°C (185°F) for a minimum of five minutes before immediate consumption can reduce the risk of illness. OTHER FACTORS Other factors contributing to the production of safe canned products include: • • • • reducing the bacterial load of fresh food to be canned by washing, trimming and peeling forming an anaerobic environment using air tight seals that prevent post-processing contamination3 detailed record-keeping of the canning process with identification and verification of critical control points, and adequate labelling of home-canned food — some of the information included on the label are: the producer information (producer name, address and date of production), ingredients and safety Home Canning |9 messages (storage requirements, best-before dates and pre-consumption messages). This would provide assistance with safe usage of the canned product, identification of potential allergens and effective trace-back, if a problem is identified later on.2 FOOD SERVICE ESTABLISHMENTS AND CANNING Food service establishments are potential high risk settings where widespread public exposure to contaminated food can occur. Affecting 37 people in 1985, the botulism outbreak from garlic in oil was the first reported and largest Canadian botulism outbreak associated with a food service establishment. In 1987, 11 people became ill after consuming home-canned mushrooms, locally canned at a hotel restaurant in Vancouver.31 In 2004, an outbreak associated with restaurant preserved home-canned olives resulted in 28 cases of botulism in Italy.20 Safe home-canning in restaurants relies on the operator starting with a validated recipe, following the recipe correctly, and implementing a satisfactory HACCP process that identifies, verifies and records the critical control points in the processing. This reduces the probability of an error during the canning process. Some of the recorded errors during the canning process are: • • • • • • inadequate validation process a change in the formulation and viscosity of the product equipment errors – e.g. temperature, processing time, pressure, failure to calibrate, wrong container size, change in headspace (the unfilled space from the top of the jar to the food or liquid in the jar), etc. failure to follow written instructions/HACCP failure to review records failure to act on adverse records.33 Conclusion This review found several reports of foodborne botulism outbreaks and illnesses associated with improperly home-canned food. Shelf-stable, home-canned products containing low acid or acidified foods, including vegetables and meat dishes, are often implicated as the most likely source. An application of high temperatures and/or an acidic environment is required to effectively control the growth and germination of pathogenic microorganism and bacterial spores during the canning process.3,33 Applying adequate temperature and acidity to control and eliminate the germination of Clostridium botulinum spores is also sufficient to effectively control the growth of other pathogenic microorganisms of concern in the home canning process, such as Bacillus and Staphylococcus aureus.5 Insufficient temperature treatment and inadequate pH in the final canned product have been identified as the most likely contributing factors in botulism illnesses and outbreaks. The US Food and Drug Home Canning |10 Administration (FDA) has identified improper acidification of home-canned foods as the cause of several botulism cases.38 In addition, foodborne botulism has also been associated with inadequate thermal processing of home-canned foods.33 In Canada, some food service establishments are producing home-canned food for public consumption. Food establishments, including restaurants, can provide widespread public exposure should a canned food become contaminated. The outbreaks associated with garlic in oil in Canada in 1985, restaurant prepared home-canned mushrooms in Vancouver in 1987, and home-canned olives in Italy in 2004 are all examples of restaurant-associated botulism outbreaks.20,31 A recent baseline study by the Ontario Ministry of Agriculture and Food (OMAF) has highlighted that a number of producers lack sufficient knowledge regarding the food safety principles of home-canned products, which has led to some of these products being recalled by the Canadian Food Inspection Agency. It has also identified concerns regarding insufficient labelling and lack of record-keeping by these operators.2 If a food service establishment is considering home canning, it is important to use validated recipes and to ensure that the required temperature and acidity is achieved. It is also imperative to implement a satisfactory HACCP system to ensure adequate delivery of this process.3,33 Canning can be a safe way of preserving and storing food for a prolonged period of time. However, if not done properly, it can result in serious illness and can have fatal consequences. It is important to understand the science of canning and implement proper control measures to ensure the safety of home-canned products. Home Canning |11 References 1. Evancho GM, Tortorelli S, Scott VN. Microbial spoilage of canned foods. In: Sperber WH, Doyle MP, editors. Compendium of the microbiological spoilage of foods and beverages. New York: Springer; 2010. p. 185-222 2. Blenkinsop R. Intrinsic and microbiological parameters of foods of plant origin processed products available at farm-gate and farmers’ markets. Presented at: Interagency Council on Food Safety; 2013 Nov 13; Toronto, ON. 3. United States Department of Agriculture, National Institute of Food and Agriculture. Complete guide to home canning. Guide 1: Principles of home canning. Washington, D.C.: United States Department of Agriculture; 2009. Available from: http://nchfp.uga.edu/publications/usda/GUIDE%201%20Home%20Can.pdf#page=2&zoom=auto,0 ,292 4. Reynolds S, Williams P, Harrison JA. So easy to preserve. 5th ed. Athens, GA: University of Georgia; 2006. 5. U.S. Food and Drug Administration. Draft guidance for industry: Acidified foods. Silver Spring, MD: U.S. Food and Drug Administration; 2010. Available from: http://www.fda.gov/downloads/Food/GuidanceRegulation/UCM227099.pdf 6. U.S. Food and Drug Administration. Inspection technical guides - water activity (aw) in foods. Silver Spring, MD: U.S. Food and Drug Administration; 1984 [cited 2014 Jan 21]. Available from: http://www.fda.gov/iceci/inspections/inspectionguides/inspectiontechnicalguides/ucm072916.ht m 7. Government of Canada. Home canning safety [Internet]. Ottawa, ON: Government of Canada; [updated 2013 Feb 8; cited 2013 Aug 29]. Available from: http://healthycanadians.gc.ca/eatingnutrition/safety-salubrite/food-canning-conserve-aliment-eng.php 8. Levine WC, Bennett RW, Choi Y, Henning KJ, Rager JR, Hendricks KA, et al. Staphylococcal food poisoning caused by imported canned mushrooms. J Infect Dis. 1996;173(5):1263–7. Available from: http://jid.oxfordjournals.org/content/173/5/1263.long 9. Peck MW. Clostridium botulinum and the safety of minimally heated, chilled foods: an emerging issue? J Appl Microbiol. 2006;101(3):556–70. 10. Rebagliati V, Philippi R, Tornese M, Paiva A, Rossi L, Troncoso A. Food-borne botulism in Argentina. J Infect Dev Ctries. 2009;3(4):250–4. Available from: http://www.jidc.org/index.php/journal/article/view/19759486/57 11. MedlinePlus. Botulism [Internet]. Bethesda, MD: U.S. National Library of Medicine; [updated 2014 Mar 18; cited 2013 Sep 4]. Available from: http://www.nlm.nih.gov/medlineplus/botulism.html Home Canning |12 12. United States Department of Agriculture, Food Safety and Inspection Service. HACCP for shelfstable processes. Washington, D.C.: United States Department of Agriculture; 2009. Available from: http://www.fsis.usda.gov/shared/PDF/FSRE_SS_HACCP_Student.pdf?redirecthttp=true 13. NSW Food Authority. Shelf stable acid preserved foods: Factors affecting the shelf stability of acid foods: Condiments, sauces and salad dressing. Silverwater, NSW: NSW Food Authority; 2013. Available from: http://www.foodauthority.nsw.gov.au/_Documents/science/shelf-stable-acidpreserved-foods.pdf 14. Loutfy MR, Austin JW, Blanchfield B, Fong IW. An outbreak of foodborne botulism in Ontario. Can J Infect Dis. 2003;14(4):206–9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094941/ 15. Abgueguen P, Delbos V, Chennebault JM, Fanello S, Brenet O, Alquier P, et al. Nine cases of foodborne botulism type B in France and literature review. Eur J Clin Microbiol Infect Dis. 2003;22(12):749–52. 16. Armada M, Love S, Barrett E, Monroe J, Peery D, Sobel J. Foodborne botulism in a six-month-old infant caused by home-canned baby food. Ann Emerg Med. 2003;42(2):226–9. 17. Sobel J, Tucker N, Sulka A, McLaughlin J, Maslanka S. Foodborne botulism in the United States, 1990–2000. Emerg Infect Dis. 2004;10(9):1606–11. Available from: http://wwwnc.cdc.gov/eid/article/10/9/03-0745_article.htm 18. Varma JK, Katsitadze G, Moiscrafishvili M, Zardiashvili T, Chikheli M, Tarkashvili N, et al. Foodborne botulism in the Republic of Georgia. Emerg Infect Dis. 2004;10(9):1601–5. Available from: http://wwwnc.cdc.gov/eid/article/10/9/03-0806_article.htm 19. Cengiz N., Turker H., Kiziltan M. Clinical and electrodiagnostic follow up of a case of food borne botulism. Marmara Medical Journal. 2004;17(1):89–92. Available from: http://www.mmj.dergisi.org/pdf/pdf_MMJ_336.pdf 20. Cawthorne A, Celentano LP, D’Ancona F, Bella A, Massari M, Anniballi F, et al. Botulism and preserved green olives. Emerg Infect Dis. 2005;11(5):781–2. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320370/ 21. McLauchlin J, Grant KA, Little CL. Food-borne botulism in the United Kingdom. J Public Health. 2006;28(4):337–42. Available from: http://jpubhealth.oxfordjournals.org/content/28/4/337 22. Cengiz M, Yilmaz M, Dosemeci L, Ramazanoglu A. A botulism outbreak from roasted canned mushrooms. Hum Exp Toxicol. 2006;25(5):273–8. 23. Pavlova V, Llieva D, Komitova R, Dimitrova D, Marina M. Outbreak of foodborne botulism in Bulgaria. Problems of Infectious and Parasitic Disease. 2007;35(2):7–8. 24. Centre for Disease Control and Prevention. Botulism from home-canned bamboo shoots-Nan province, Thailand, March 2006. MMWR. 2006;55(14):389–92. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5514a1.htm Home Canning |13 25. Ungchusak K, Chunsuttiwat S, Braden C, Aldis W, Ueno K, Olsen S, et al. The need for global planned mobilization of essential medicine: lessons from a massive Thai botulism outbreak. Bull World Health Organ. 2007;85(3):238–40. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636242/ 26. Swaan CM, van Ouwerkerk IM, Roest HJ. Cluster of botulism among Dutch tourists in Turkey, June 2008. Euro Surveill. 2010;15(14). pii: 19532. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19532 27. Date K, Fagan R, Crossland S, Maceachern D, Pyper B, Bokanyi R, et al. Three outbreaks of foodborne botulism caused by unsafe home canning of vegetables--Ohio and Washington, 2008 and 2009. J Food Prot. 2011;74(12):2090–6. 28. Oriot C, D’Aranda E, Castanier M, Glaizal M, Galy C, Faivre A, et al. One collective case of type A foodborne botulism in Corsica. Clin Toxicol (Phila). 2011;49(8):752–4. 29. Lonati D, Locatelli CA, Fenicia L, Anniballi F, Landri P, Giampreti A, et al. Fatal course of foodborne botulism in an eight-month old infant. Pediatr Rep. 2011;3(4):e31. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283199/ 30. Ağaçayak A. A case of food-borne botulısm by consumptıon of home-made canned red pepper: Importance of the botulısm antıtoxın therapy. Afr J Microbiol Res. 2011;5(27):4885–8. 31. Leclair D, Fung J, Isaac-Renton JL, Proulx J-F, May-Hadford J, Ellis A, et al. Foodborne botulism in Canada, 1985-2005. Emerg Infect Dis. 2013;19(6):961–8. Available from: http://wwwnc.cdc.gov/eid/article/19/6/12-0873_article.htm 32. Hill SE, Iqbal R, Cadiz CL, Le J. Foodborne botulism treated with heptavalent botulism antitoxin. Ann Pharmacother. 2013;47(2):e12. 33. Pflug IJ. Science, practice, and human errors in controlling Clostridium botulinum in heat-preserved food in hermetic containers. J Food Prot. 2010;73(5):993–1002. 34. Goff HD (University of Guelph). Dairy science and technology education series: thermal destruction of microorganisms [Internet]. Guelph, ON: University of Guelph; c2009 [cited 2014 May 30]. Available from: https://www.uoguelph.ca/foodscience/dairy-science-and-technology/dairyprocessing/pasteurization/thermal-destruction-microorganisms 35. Oomes SJCM, van Zuijlen ACM, Hehenkamp JO, Witsenboer H, van der Vossen JMBM, Brul S. The characterisation of Bacillus spores occurring in the manufacturing of (low acid) canned products. Int J Food Microbiol. 2007;120(1-2):85–94. 36. Stringer SC, Haque N, Peck MW. Growth from spores of nonproteolytic Clostridium botulinum in heat-treated vegetable juice. Appl Environ Microbiol. 1999;65(5):2136–42. Available from: http://aem.asm.org/content/65/5/2136.full 37. Kendall P (Colorado State University). Botulism [Internet]. Fort Collins, CO: Colorado State University; c2014 [updated 2014 Jan 8; Cited 2014 Jun 2]. Available from: http://www.ext.colostate.edu/pubs/foodnut/09305.html Home Canning |14 38. Derossi A, Fiore AG, De Pilli T, Severini C. A review on acidifying treatments for vegetable canned food. Crit Rev Food Sci Nutr. 2011;51(10):955–64. 39. Ontario. Ministry of Citizenship and Immigration. Exploring Ontario: Geography and climate [Internet]. Toronto, ON: Queen's Printer for Ontario; c2009 [updated 2014 Mar 5; cited 2014 May 30]. Available from: http://www.ontarioimmigration.ca/OI/en/about/OI_ABOUT_GEOGRAPHY_CLIMATE.html 40. Fellows PJ. Food processing technology: Principles and practice. 3rd ed. Boca Raton, FL: Woodhead Publishing Limited; 2009. 41. Ball Corporation. Ball Canning [Internet]. Daleville, IN: Ball Corporation; c2013 [cited 2013 Nov 22]. Available from: http://www.freshpreserving.com Home Canning |15 Appendix I Search strategies: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present # Searches Results 1 Food Preservation/ 9441 2 Food Handling/ 16223 3 Food, Preserved/ 233 4 exp Food Safety/ 53089 5 Food Contamination/ 28509 6 Food Microbiology/ 25312 7 Food Storage/ 413 8 Food Packaging/ 2430 9 *Food/ 11809 10 Foodborne Diseases/ 7351 11 Botulism/ 2629 12 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 87022 13 (acidic or acidity or outbreak$ or disease$ or illness$ or botuli$ or toxic$ or toxin$ or 6253746 health hazard$ or safety or risk$ or bacteria or foodborne$ or (food adj2 poison$)).mp. 14 (canning or canned or home-cann$).mp. 1920 15 12 and 13 and 14 329 16 13 and 14 640 17 limit 16 to ("in data review" or in process or "pubmed not medline") 41 18 15 or 17 370 Embase 1974 to 2013 Week 22 # Searches 1 canned food/ 2 food preservation/ 3 food handling/ 4 food safety/ 5 food contamination/ 6 food storage/ 7 food poisoning/ 8 food packaging/ 9 *food/ 10 botulism/ 11 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 12 (canning or canned or home-cann$).mp. 13 11 and 12 14 1 or 13 15 (acidic or acidity or outbreak$ or disease$ or illness$ or botuli$ or toxic$ or toxin$ or health hazard$ or safety or risk$ or bacteria or foodborne$ or (food adj2 poison$)).mp. Results 689 8678 14986 8648 34117 3706 11548 5423 18914 3675 93393 2515 990 1403 8054149 Home Canning |16 16 14 and 15 17 limit 16 to exclude medline journals 531 50 CINAHL with Full Text # Query S1 (MH "Food Safety") OR (MH "Food Preservation") OR (MH "Food Handling") OR (MH "Food Packaging") OR (MH "Food Contamination") OR (MH "Food Microbiology") OR (MM "Food") OR (MH "Food Poisoning") OR (MH "Botulism") S2 acidic or acidity or outbreak* or disease* or illness* or botuli* or toxic* or toxin* or health hazard* or safety or risk* or bacteria or foodborne* or (food N2 poison*) S3 canning or canned or home-cann* S4 S1 AND S2 AND S3 Environment Complete # Query S1 SU canning or canned or home-cann* S2 acidic or acidity or outbreak* or disease* or illness* or botuli* or toxic* or toxin* or health hazard* or safety or risk* or bacteria or foodborne* or (food N2 poison*) S3 SU food* or botulism S4 S1 AND S2 AND S3 Scopus # Query S1 (TITLE(canned OR canning OR home-cann*) OR KEY(canned OR canning OR home-cann*)) AND (TITLE(food* OR botulism) OR KEY(food* OR botulism)) AND (TITLE(acidic or acidity or outbreak* or disease* or illness* or botuli* or toxic* or toxin* or health hazard* or safety or risk* or bacteria or foodborne* or (food W/2 poison*)) or KEY(acidic or acidity or outbreak* or disease* or illness* or botuli* or toxic* or toxin* or health hazard* or safety or risk* or bacteria or foodborne* or (food W/2 poison*))) Results 7,907 721,562 133 24 Results 2,251 696,222 55,751 400 Results 260 Home Canning |17 Public Health Ontario 480 University Avenue, Suite 300 Toronto, Ontario M5G 1V2 647.260.7100 communications@oahpp.ca www.publichealthontario.ca